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Full text of "Diseases Of The Nose Throat And Ear"

CANCER OF THE LARYNX

183

gullet. The upper airway is detached from the lower airway by the removal of
the larynx and there is no way of joining them up again. The trachea is
therefore brought out on to the surface as a permanent end tracheostome
(Fig. 91). It will never be closed, but most patients quickly adjust to life with a

Fig. 90. Laryngeciomy showing area to be
removed. 1, Mandible; 2. Hyoid bone; 3,
Thyroid cartilage; 4, Cricoid cartilage; 5,
Trachea; 6, Line of excision.

Fig. 91. Laiyngectomy showing end result after
removal. 1, Pharynx sutured to base of tongue;
2, Lumen of pharynx; 3, Permanent
tracheostome.

permanent tracheostomy. After a few weeks they can dispense with the
tracheostomy tube and conceal the hole with a collar and tie. With eifective
speech therapy instruction about 60 per cent will learn to speak again in a
satisfactory manner using oesophageal speech. Once the technique has been
mastered the patient produces a sound from the reconstructed gullet by